Erin Kaseda and Dr. Wendy Birmingham, Psychology Department

Introduction

It is estimated that between 5-10% of children and adolescents in the United States have been diagnosed with attention-deficit/hyperactivity disorder (ADHD). For adolescents with ADHD, parent-child relationships and peer relationships may experience increased conflict. Interpersonal difficulties among family members put children with ADHD at risk for comorbid disorders, including depression and anxiety. Very little research has been done on children’s own perception of the quality of parental support and its role in self-control behaviors. Understanding which parental supportive behaviors are perceived as the most helpful may allow clinicians to target interventions to best improve the resilience of adolescents with ADHD.

Methodology

To address the question of how parental support influences the self-control of adolescents with ADHD, this study examined adolescents ages 14-19 diagnosed with ADHD. In the preliminary analysis, 10 adolescents (mean age=17, N= 7 female) with a diagnosis of ADHD completed surveys on their attitudes towards each of their parents and participated in a semi-structured interview. Participants were asked questions about self-control in school and in home settings, how their relationship with their parents influence their self-control, and their overall perceptions of their parent-child relationships. The interviews were transcribed verbatim and coded for factors that improve adolescents’ comfort in confiding in or sharing their feelings with their parents.

Subjects also participated in two measures of inhibition control. First, the subjects underwent a functional MRI scan while playing a Go/No-go task. In this task, participants were briefly presented with images of foods. If the food was healthy, they were instructed to push a button on a controller, which they held inside of the MRI scanner. However, if the food was unhealthy, they should withhold their response. The purpose of this task is to assess differences in neural activation when responding (pressing the button) versus when inhibiting a response (not pressing the button). The functional MRI analysis is in progress. The second measure of inhibition control came from the NIH Toolbox kit of cognitive assessments. In this portion of the study, participants completed the Flanker Inhibitory Control and Attention Test, as well as the Pattern Comparison Processing Speed Test and the List Sorting Working Memory Test.

Results

Participants were mostly white (50%) or Latino/a (40%) and from middle- to high-income families. Participants reported low relational distress with their mothers (M=28.1/100) and their fathers (M=32.2/100). When asked how comfortable they felt confiding in their parents, only 33% of subjects reported feeling very comfortable. Participants gave examples of specific supportive actions their parents take that make it easier for them to confide in them. Responses included, “She just tries to be there…the effort’s really nice;” and “Actually putting their words away for a minute to just listen.” Participants also reported on specific actions their parents take that make it more difficult for them to confide in them. Responses included, “I can’t tell them the things I feel guilty about…it’s scary;” “If they give me advice that I think [was] a little bit too judgmental, I’ll probably not come back to them;” and “There’s just kind of a difference in perspective.” Additionally, 30% of participants also reported that there is no one they are likely to go to for support or advice about self-control, inside or outside of their families, including their peers.

Among older adolescents (18-19) who have recently undergone the transition from high school to university, there was a significant relationship between perceived family supportiveness and inhibitory control as measured by the Flanker Inhibitory Control and Attention Test, such that individuals with poorer family support show higher inhibitory control. This was true of overall family relations (P = .05), maternal supportiveness (P = .03), and paternal supportiveness (P = .04). Perceived family supportiveness was not significantly related to either working memory or processing speed.

Discussion

This preliminary analysis, demonstrated that quality of family and parent-child relationships significantly affects the inhibition control of adolescents with ADHD. The original hypothesis was that higher levels of parental support would result in higher levels of inhibitory control – however, we found that this correlation was in the opposite direction among 18- and 19-year-olds. One possible explanation for this is that older adolescents who perceive their families as unsupportive are more likely to seek independent methods for improving inhibitory control at work and at home because they are unlikely to rely on their parents for support in changing habits and behaviors. Every adolescent who reported low levels of supportiveness from their parents also reported that they are not likely to go to at least one parent for support or advice, citing reasons such as, “We disagree on pretty much everything…we don’t have real conversations,” “My dad pretty much gets mad at everything…which is not very conducive to confiding in him,” and “He lies a lot…I don’t trust him.” It is also important to note that this negative correlation is only present in older adolescents aged18 to 19 who no longer live with their parents year-round, and was not seen in younger adolescents still living at home.

Additionally, the self-reported factors from the interviews suggest that many complex aspects of parent-child relationships, including communication, trust, and perceived motives also influence the extent to which adolescents with ADHD feel comfortable confiding in their parents and how likely they are to go to their parents for support or advice. These factors may be useful in developing therapeutic plans to improve parent-child relationships in families where one or more children have been diagnosed with ADHD.

Conclusion

Understanding adolescents’ own perception of parental support and factors that make it difficult for them to confide in their parents has significant potential for clinicians in creating family-based interventions for adolescents with ADHD. In particular, applying factors that improve adolescent comfort in confiding in parents has the potential to support adolescents with ADHD who are facing problems with self-control both at school and at home. Additionally, the finding that a third of subjects do not have peers or other adults that they feel comfortable going to for support is significant for school-based interventions. To better understand the differences in perceived family functioning and peer relationships between adolescents with ADHD and their typically developing peers, further research is needed that examines broad social connectivity and includes adolescents with no history of psychiatric or neurological illness.